Failing the rights: sexual vulnerability, access to services and barriers to contraceptives among adolescents in Narok County, Kenya

Abstract

Purpose Around one in five girls in Kenya, aged 15 to 19 years old are either pregnant or have given birth. Of 47 counties, adolescent pregnancy is highest in Narok, where about 40% of girls aged 15 to 19 years old have begun childbearing. This study aims to explore drivers to sexual activity, access to sexual and reproductive health (SRH) services and barriers to contraceptive use among adolescents in Narok County, Kenya to inform the design of SRH interventions and safeguard young people’s rights to sexual health. Design/methodology/approach A cross-sectional mixed methods study was conducted in December 2019. Quantitative data were collected through structured questionnaires among girls aged 15 to 19 years old who were either pregnant or had given birth and those who had not and boys aged 15 to 19 years old. Qualitative data were collected through focus group discussions with adolescent girls and boys and through structured key informant interviews with parents, community leaders and health workers. Findings The mean age at first sexual intercourse for both genders was 15 years. While the majority of girls and boys knew where to access SRH services, few used contraception during their last sexual activity. There was no significant difference in the condom or other contraceptive methods use between girls who had begun child bearing and those who had not (p = 0.549 and p = 0.563, respectively). Key drivers for sexual activity among young people were poverty and peer pressure. Cultural practices such as female genital mutilation and early marriage contributed to early sex. Community attitudes toward contraception discouraged young people from taking up contraceptives. Originality/value This mixed methods study explores the drivers of adolescent pregnancy in Narok, Kenya, the county with the highest rates of adolescent pregnancy; twice the national pregnancy rates. Understanding the drivers of pregnancy and the underlying human rights violations will help policymakers and health leaders to design interventions which will improve outcomes.

Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study

“…Secondly, it could be due to limited quality health services, myths and misconceptions as factors that affected FP use at the time of relocation to another country before being settled in a host community. This concurs with several studies [ 39 – 41 ] which revealed that weak health system and poor health services affect the use of FP.…”

A critical review of adolescent sexual and reproductive health and rights in Kenya

“…From focused group discussions with the adolescents and key informant interviews with their caregivers, health workers, and community leaders, open discussions on sex and sexuality among girls and their parents or caregivers were less frequent because this was considered against community norms. 7 This mirrors what has been reported in other studies in Africa where boys are stereotyped as sexually active, girls as sexually restrained, and societies believe that the sexual agency of girls should be restricted as a way of protecting the girls. 8 Such gender norms are established early in life and have a substantial impact on adolescent girls' agency.…”

“…6 In 2019, we did a mixed methods study on adolescent pregnancy and SRH rights among Kenyan boys and girls aged 15 to 19 years old. 7 From this study, adolescent boys reported greater access to SRH information and services, were more knowledgeable about SRH topics, including contraceptive methods, and were more likely than girls to have dialogues about sex and ll Med 3, 361-368, June 10, 2022 365 Commentary sexuality with their parents and caregivers. From focused group discussions with the adolescents and key informant interviews with their caregivers, health workers, and community leaders, open discussions on sex and sexuality among girls and their parents or caregivers were less frequent because this was considered against community norms.…”

“…This question of adolescents' ability to understand SRH information also comes up when discussing whether parental consent should be sought when adolescents seek SRH services and many stakeholders' opinions differ on this. In our 2019 study in Kenya, 7 we discovered that some health workers were opposed to providing contraceptive information and services to adolescents without their parents' consent as they did not know if this was legal or not.…”

Attitude and prevalence of early sexual debut and associated risk sexual behavior among adolescents in Tanzania; Evidence from baseline data in a Randomized Controlled Trial

“…However, teens (10 to 19 years) are the most susceptible to the negative effects of unprotected sex because, according to UNICEF, these behaviours are linked to two-thirds of adult premature deaths and one-third of the entire burden of diseases [ 8 ]. Drug use, poor parenting, peer pressure, sociocultural standards, mass media, and individual sexual attitudes are all occasionally associated with the behaviours [ 9 , 10 ]. Unsafe sexual behaviours are a health determinant that is frequently connected to unintended pregnancies and the obstetric outcomes they are associated with, such as anemia, puerperal psychosis, eclampsia, fistula, abortion, and hemorrhage, to name a few, as well as new STIs/HIV infections [ 11 , 12 ].…”